AAPM&R Advocates for You! As the primary medical society for physical medicine and rehabilitation, AAPM&R is the organization that advocates on behalf of PM&R physicians and their patients. We position PM&R physicians as essential leaders early and across the healthcare continuum, defend against threats to PM&R practices and provide members with a powerful voice and opportunities to advocate for the specialty. With your support this year, we submitted more than 1,400 letters to Congress, sent more than 50 comment letters to federal and local regulatory agencies, and secured 45 volunteers to serve on national and clinical workgroups. aapmr.org/advocacy Throughout 2023, the Academy has prioritized: Defending the Role of Physiatrists Against Encroachment from Non-PM&R Physicians and Non-Physicians Advocating for Expanded Telehealth Innovations and Enhanced Ways for Physiatrists to Advance Patient Care Advancing Long COVID Advocacy to Position PM&R Physicians as Leaders in Multi-Disciplinary Care Preparing Physiatrists to Navigate Through the End of the COVID-19 Public Health Emergency Advocating for Your Patients Fighting Against PM&R Physician Fee Cuts and For Improved PM&R Physician Payment Fighting to Reduce Physiatrist Burden by Removing Prior Authorization Barriers Working to Preserve Physiatrists’ Expertise in Determining Medical Necessity in Inpatient Rehabilitation Facility (IRF) Admissions 1 5 6 7 8 2 3 4
Defending the Role of Physiatrists Against Encroachment from Non-PM&R Physicians and Non-Physicians AAPM&R continues fighting national and local scope of practice expansion battles to protect and preserve the leadership role of physiatrists on the healthcare team. WINS CAMPAIGNS 1 LETTERS SENT OPPOSING INAPPROPRIATE SCOPE OF PRACTICE EXPANSION 650+ R In partnership with the Multi-Society Pain Workgroup, we submitted comments to the Oklahoma State Legislature opposing Oklahoma HB 2168, which would allow certified registered nurse anesthetists to perform interventional pain procedures. The comments were successful in defeating the bill. R Solicited Academy members in New York to stop the elimination of oversight of physician assistants (PAs) in Part W of the Governor’s proposed Health and Mental Hygiene Budget (A.3007/S.4007). Academy members sent more than 80 letters to state officials. The final budget was signed by the Governor on May 3 and the provision eliminating the oversight of physician assistants was removed. R In late 2022 the National Basketball Association (NBA) modified their Team Health and Performance Personnel policy, effectively placing unique and unwarranted limitations on physiatrists’ capacities to serve as medical team physicians in the NBA. Once aware of this announcement, the Academy worked quickly to coordinate an action plan that included fact-seeking dialogue with NBA executive and medical leadership, and engagement with various multidisciplinary sports medicine organizations. AAPM&R also created a workgroup to elevate the understanding and value of what we do in sports medicine and proactively position PM&R as leaders in sports medicine.
CAMPAIGNS (CONTINUED) RESOURCES Learn more at aapmr.org/scopeofpractice. Jack Smith, MD © 2023 American Medical Association. All rights reserved. 23-845836:3/23 Not sure what these letters mean? American Academy of Physical Medicine and Rehabilitation Ask for a physician. Scan this code to see why medical education matters. Will a physician be involved or overseeing my care and treatment plan? For example, will a physician be reviewing my chart, lab results, x-rays and other tests? Physicians (MDs and DOs) are the only health care professionals who complete four years of medical school, three-to-seven years of supervised postgraduate training (known as“residency”), and a comprehensive licensing exam series before they are eligible for an unlimited medical license. However, did you know that not every state requires physicians to be involved in patient care? To be an informed patient, here are some questions to help whether a physician (MD or DO) will be involved in your care: Remember—you have the power to ask for a physician. Ask for a physician Are you working with a physician? Please tell me, “Are you a physician?” Is a physician available if I have any questions during or after my visit? –1– ® Post-Acute Care Settings Post-acute care is defined by CMS as care after an acute hospitalization that includes treatment in an Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), Long-term Care Hospital (LTCH) and Home Health Agency (HHA). The selection of the appropriate PAC setting for an individual patient largely depends on the diagnosis, functional status, expected gains in function and ability to participate in therapy, but there are several important non-clinical factors to consider. Some of these factors include geographic availability of various types of PAC settings, patient preference for a PAC setting close to home, home accessibility and level of caregiver assistance available at the time of discharge. The availability of funding is another important factor that influences the selection of PAC location. Inpatient Rehabilitation Facilities (IRFs) Inpatient Rehabilitation Facilities (IRFs) serve patients with complex rehabilitation needs and are highly regulated regarding patients admitted, physician involvement and the requirement for intensive therapy services, (generally considered to be 3 hours of therapy per day, 5 days per week, although there are other ways to define intensive therapy services). In 2014, there were about 1,180 IRFs in the United States and Medicare fee for service covered about 339,000 beneficiaries in 376,000 IRF stays.1 There are increasing restrictions on IRF admissions and pressure to reduce the overall length of stay in IRFs to provide an efficient treatment program while maximizing functional outcomes. Skilled Nursing Facilities (SNFs) When patients have rehabilitation needs that do not require the intensity of interdisciplinary services provided in an IRF setting, they may benefit from a rehabilitation program to optimize American Academy of Physical Medicine and Rehabilitation Position Statement: Physiatrists Role in Skilled Nursing Facilities Physiatrists have the knowledge and expertise to serve an important patient care and leadership role in all post-acute care (PAC) settings, including Skilled Nursing Facilities (SNFs). Physiatrists are optimally suited by way of the unique combination of medical and functional knowledge and expertise to achieve the highest functional outcome for patients at the least financial cost to our society. recovery and functional outcomes in a SNF setting. Skilled Nursing Facilities are an increasingly important setting for provision of rehabilitative care in the United States health system, with more patients receiving rehabilitation treatment in SNFs than in hospitals and acute inpatient rehabilitation units. In 2014, about 15,000 skilled nursing facilities provided skilled care to 1.7 million patients and 2.4 million Medicare fee for service covered stays.2 Skilled Nursing Facilities vary considerably in their ability to provide a rehabilitation treatment program. Rehabilitation in a SNF setting is often described as subacute rehabilitation, but subacute rehabilitation does not have a consistent definition and is not defined in Medicare or other regulations. Medicare does define criteria for designation as a skilled nursing facility. “Skilled nursing facilities (SNFs) provide short-term skilled nursing care and rehabilitation services such as physical and occupational therapy and speech-language pathology services.”3 Medicare will cover up to 100 days of SNF care after a hospital stay of at least 3 days. Medicare has detailed regulations regarding funding of a patient stay in a SNF. Medicare will cover SNF level care if all of the following are met: • The patient requires skilled nursing services or skilled rehabilitation services, i.e., services that must be performed by or under the supervision of professional or technical personnel; are ordered by a physician and the services are rendered for a condition for which the patient received inpatient hospital services; • The patient requires these skilled services on a daily basis and; • The daily skilled services can be provided only on an inpatient basis in a SNF. continued on page 2 » Jack Smith, MD © 2023 American Medical Association. All rights reserved. 23-845836:3/23 Not sure what these letters mean? American Academy of Physical Medicine and Rehabilitation Ask for a physician. Scan this code to see why medical education matters. R Contacted members of Congress to oppose the Improving Care and Access to Nurses Act (H.R. 2713), which would inappropriately expand scope of practice for nurse practitioners and other advanced practice registered nurses under the Medicare program, removing physicians from their proper role as head of the healthcare team and diminishing the quality of care available to patients. R Contacted members of Congress to oppose the Improving Access to Workers’ Compensation for Injured Federal Workers Act (S. 131/H.R. 618), which would inappropriately expand the scope of practice for nurse practitioners and physician assistants under the federal Worker’s Compensation Program. R In response to a draft coverage policy proposal that recommended expanding the scope of practice for non-physician providers for intraoperative neurophysiological monitoring services, we submitted a joint statement with the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) affirming the necessity of physician supervision for these medical services. R Partnered with the American Medical Association (AMA) to release a new resource to empower patients to ask questions about the qualifications of who is providing their healthcare – the “Ask for a Physician” Patient Card. The card includes a QR code that directs patients to a webpage with a high-level overview of the differences in education and training between physicians and non-physicians. R Published an in-depth job description for physiatrists in SNFs and updated AAPM&R’s Position Statement on Physiatrists’ Role in Skilled Nursing Facilities to ensure that PM&R physicians are equipped with the best resources to promote, protect and demonstrate their immense value within this setting.
Fighting Against PM&R Physician Fee Cuts and For Improved PM&R Physician Payment AAPM&R remains committed to pursuing fair reimbursement for physician-led care in the evolving healthcare environment. WINS CAMPAIGNS 2 LETTERS SENT TO CMS VOICING CONCERNS ABOUT PAYMENT CUTS AND POLICIES WHICH COULD NEGATIVELY IMPACT PM&R PHYSICIANS 142 R Medicare physician payment reform was a top priority during Congressional meetings for our annual Hill Day, where we advocated for highquality, high-value care and sustainable positive annual updates to the Medicare Physician Fee Schedule while meeting with more than 20 Congressional offices. Faced with the immediate threat of reduced payment in 2024, we will continue to engage Congress and encourage members to contact their representatives via grassroots advocacy. R Submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the 2024 Medicare Physician Fee Schedule Proposed Rule. Comments identified areas in which CMS proposals could negatively impact payment for physiatric services. Our #PMRAdvocates sent 142 letters to CMS voicing concerns about payment cuts and policies which could negatively impact PM&R physicians. R Submitted comments to the CMS Innovation Center Request for Information on New Episode-Based Payment Models using the Academy’s Principles of Alternative Payment Models. We provided suggestions on designing and implementing new episode-based payment models focused on accountability for quality and cost, health equity and specialty integration.
COLLABORATIONS AND CRITICAL MEETINGS RESOURCES Learn more at aapmr.org/reimbursement. R AAPM&R representatives attended the AMA Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) meetings to advocate for correct coding language and code valuation for physiatry services. R Developed several educational articles for members in The Physiatrist newsletter on topics including 2023 reimbursement and coding changes, split (or shared) billing and documentation tips, and the new Medicare sacroiliac joint procedure policies. Read more at www.aapmr.org/members-publications/newsletters/the-physiatrist-newsletter.
Fighting to Reduce Physiatrist Burden by Removing Prior Authorization Barriers AAPM&R’s efforts aim to reduce the burden of your daily work by exposing the flaws of the “peer-to-peer” system and decreasing lengthy response times from insurance plans while protecting the aspects of your career that you enjoy. WINS CAMPAIGNS Learn more at aapmr.org/reducingburden. 3 MESSAGES SENT TO CONGRESSIONAL REPRESENTATIVES URGING SUPPORT FOR THIS LETTER AND FOR COMMON-SENSE REFORMS TO THE PRIOR AUTHORIZATION PROCESS. 350+ R We continue to push CMS on regulatory reforms to reduce the burdens imposed by unnecessary prior authorization requirements through individual Academy comments and coalition sign-on letters in 2023. R Endorsed H.R. 4968, the Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act, legislation to allow Medicare Advantage plans to waive or reduce prior authorization requirements for clinicians who demonstrate a track record of compliance with a plan’s procedures. R A bipartisan majority of Congress joined together to send a letter to CMS urging swift finalization of regulations to streamline and reform the prior authorization process. Academy members sent 350+ messages to Congressional representatives urging support for this letter and for common-sense reforms to the prior authorization process. COLLABORATIONS AND CRITICAL MEETINGS R We partner with numerous coalitions to amplify our impact: N Regulatory Relief Coalition, a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare. N We also participate in other coalitions working to reform prior authorization processes, including the Coalition to Preserve Rehabilitation.
Learn more at aapmr.org/irfadmissions. Working to Preserve Physiatrists’ Expertise in Determining Medical Necessity in Inpatient Rehabilitation Facility (IRF) Admissions AAPM&R strongly defends the vital role of the rehabilitation physician in making the complex medical decision to admit a patient to an IRF. CAMPAIGNS 4 R The Office of the Inspector General (OIG) is conducting a nationwide audit of claims from October 2021-September 2022. AAPM&R has partnered with the American Medical Rehabilitation Providers Association and the Federation of American Hospitals to provide feedback on the audit while the OIG conducts its work. The goal of this innovative project is to identify specific areas that might require clarification in the regulations and make meaningful recommendations to decrease the IRF admissions error rate and have a positive impact on the Medicare IRF benefit. R Despite strong ongoing opposition from your Academy, CMS began the Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) in Alabama in August. The RCD requires CMS contractors to review an IRF’s documentation to determine if beneficiaries meet the IRF RCD coverage requirements. AAPM&R has formally registered significant concerns about the RCD since it was initially announced by CMS in December 2020, and we were successful in convincing CMS to not begin this burdensome program during an already challenging public health emergency. We are communicating with CMS officials and will continue to closely track and respond to all developments with the demonstration (previous comments can be found at aapmr.org/testimonyandwrittencomments).
Advocating for Expanded Telehealth Innovations and Enhanced Ways for Physiatrists to Advance Patient Care AAPM&R strongly supports the coverage of telehealth services and encourages members to utilize telehealth as an expansion of their practice. WINS CAMPAIGNS Learn more at aapmr.org/telehealth. 5 R We joined other organizations to advocate for keeping telehealth waivers in place through the end of 2024, and our advocacy efforts were successful! Payment parity, as well as an expanded list of covered services, remain in place through December 1, 2024. R We continue to advance advocacy strategies in telehealth to support establishing a permanent, comprehensive telehealth reform through payment parity, continued coverage, waiver expansions and interstate licensure agreements. RESOURCES R We published a white paper, Telehealth in PM&R: Past, Present and Future in Clinical Practice and Opportunities for Transitional Research, addressing telehealth innovations in physiatry and a range of practical telehealth educational resources for members.
WINS CAMPAIGNS Learn more at aapmr.org/longcovidadvocacy. R In July 2023, the White House answered our call to action and officially opened a new Office of Long COVID Research and Practice to lead the whole-of-government response and to implement the National Research Action Plan on Long COVID. R Following advocacy efforts from AAPM&R, the U.S. Department of Health and Human Services (HHS), through the Agency for Healthcare Research and Quality, published a funding opportunity for Long COVID research. HHS recently announced the grant awards, and we are thrilled to share that six of the nine Long COVID clinics to receive this funding are part of our MultiDisciplinary PASC Collaborative. Each awardee will receive $1 million for up to five years and this grant goes directly to clinics to use at the point of care. R Advocated for federal legislation to provide more resources for the fight against Long COVID. These initiatives in the current session of Congress include: the CARE for Long COVID Act, from Senator Tim Kaine (D-VA), and the Long COVID RECOVERY NOW Act, introduced by Representative Lisa Blunt Rochester (D-DE). AAPM&R worked with these Congressional offices to develop the legislative initiatives and is working to build support to get these bills signed into law. Learn more at aapmr.org/covid. R We also joined a coalition letter to Congressional leaders, asking the relevant committees to make Long COVID a priority and provide additional resources and funding for continued research of Long COVID. Advancing Long COVID Advocacy to Position PM&R Physicians as Leaders in Multi-Disciplinary Care Since March 2021, we have been leading an extensive advocacy effort to support 6the urgent needs of America’s Long COVID patients. RESOURCES R Our press coverage and newsroom – To date, we connected PM&R physicians with 120+ major national media outlets to discuss how vital PM&R physicians are in healthcare. Our members are touting their expertise, not only with Long COVID, but also on a variety of clinical topics, such as back pain, sports medicine, cancer rehabilitation medicine, geriatric PM&R and more. Learn more at aapmr.org/newsroom. R Our Multi-Disciplinary PASC Collaborative continues to develop clinical guidance to improve quality-of-care. N Those guidance statements focus on: fatigue, breathing discomfort, cognitive symptoms, cardiovascular complications, pediatrics, autonomic dysfunction, neurological symptoms (new in 2023!) and mental health (new in 2023!).
Preparing Physiatrists to Navigate Through the End of the COVID-19 Public Health Emergency To prepare for the end of the federal COVID-19 PHE declaration on May 11, 2023, we provided members with an online resource containing the most up-to-date information on which COVID-19 flexibilities were scheduled to end, which waivers were scheduled to be extended on a temporary basis and which became permanent. WINS Learn more at aapmr.org/phe. 7 R CMS dramatically expanded coverage of seat elevation systems in power wheelchairs for Medicare beneficiaries, an advancement that comes after many years of advocacy from AAPM&R and our members who treat patients that rely on seat elevation systems to perform daily activities. This is a significant step forward in expanding equity and access to critically important medical technology, and will improve the quality of life for patients that rely on power wheelchairs. R The National Institute of Minority Health and Health Disparities (NIMHD) announced that it will designate people with disabilities as a health disparity population for research undertaken by the National Institutes of Health (NIH). This groundbreaking move, which follows years of advocacy from AAPM&R, will help address health disparities faced by people with disabilities and ensure that NIH research going forward will include their perspectives. R The AAPM&R Delegation to the American Medical Association successfully introduced and gained approval for two resolutions that addressed increasing accessibility for users of wheelchairs on airplanes and expediting repairs for power and manual wheelchairs. R Your Academy was asked by the U.S. Government Accountability Office (GAO) earlier this year to provide expert input for a study on the quality of care currently available for patients with limb loss and limb difference, as well as ways that our national healthcare system can be improved for this patient population. Advocating for Your Patients AAPM&R is a powerful ally in advancing the causes important to you and your patients. 8
COLLABORATIONS AND CRITICAL MEETINGS RESOURCES Learn more at aapmr.org/advocacy. R Created a task force to explore the Academy’s engagement on societal concerns impacting health equity. The task force will oversee the newly formed Social Determinants of Health (SDOH) Workgroup. R Accepted the invitation to participate in the newly formed AMA Firearm Injury Prevention Task Force and the Healthcare Coalition for Firearm Injury Prevention. Both groups aim to advance firearm injury prevention using a public health approach. R Joined the National Traumatic Brain Injury (TBI) Registry Coalition, a collaborative dedicated to advocating for the federal government to create a national registry for individuals living with a TBI. R Published a position statement, “Opposing Government Interference in the Patient-Physician Relationship” in recognition that this time-honored relationship is essential to the provision of safe, effective and high-quality medical care.
Our Academy volunteers made this important work happen. Thank you to the following committees, as well as workgroup members and liaisons, for your ongoing efforts to advocate for your specialty and your patients! Quality, Practice, Policy, and Research Committee Evidence, Quality and Performance Committee Health Policy and Legislation Committee Innovative Payment and Practice Models Committee Reimbursement and Policy Review Committee State Advocacy Committee We NEED members like YOU to JOIN our advocacy efforts. Learn more and get involved at aapmr.org/advocacy.